Transcatheter aortic valve replacement with new-generation devices: A systematic review and meta-analysis

• Published in: International journal of cardiology Vol. 245; pp. 83 - 89
• Main Authors: Barbanti, Marco, Buccheri, Sergio, Rodés-Cabau, Josep, Gulino, Simona, Généreux, Philippe, Pilato, Gerlando, Dvir, Danny, Picci, Andrea, Costa, Giuliano, Tamburino, Corrado, Leon, Martin B., Webb, John G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.10.2017
• Subjects: Aortic stenosis; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Heart Valve Prosthesis - trends; Humans; Meta-analysis; Prosthetic heart valves; Systemic review; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - mortality; Transcatheter Aortic Valve Replacement - trends; Transcatheter valve interventions; Treatment Outcome; Aortic stenosis; Systemic review; Transcatheter valve interventions; Prosthetic heart valves; Meta-analysis
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2017.07.083

The aim of this study was to conduct a weighted meta-analysis to determine the rates of acute (≤30days) major outcomes after (TAVR) with second-generation devices. A comprehensive search of multiple electronic databases from January 2011 to May 2017 was conducted using predefined criteria. New-generation TAVR devices were defined as any device which received CE mark approval or is still under evaluation for CE marking after CoreValve and SAPIEN XT prostheses. A total of 37 studies including 10,822 patients met inclusion criteria and were included in the analysis. Devices investigated in the studies were the following: SAPIEN 3 (n=5423, 45.9%), Lotus Valve (n=3007, %), Portico (n=130, 1.1%), JenaValve (n=345, 2.9%), Symetis Acurate (n=1314, 11,1%), and Evolut R (n=1603, 13.6%). Thirty-day all-cause and cardiovascular 30-day death were 2.2% (95% CI: 1.6% to 2.8%) and 1.6% (95% CI: 0.9% to 2.3%), respectively; Any stroke and major/disabling stroke occurred at a pooled estimate rate of 2.6% (95% CI: 2.0% to 3.3%) and 0.9% (95% CI: 0.2% to 1.6%), respectively; life-threatening bleeding, 3.9% (95% CI: 2.9% to 5.0%); major vascular complications, 4.5% (95% CI: 3.7% to 5.4%); pacemaker implantation, 16.2% (95% CI: 12.7% to 19.6%); more than mild aortic regurgitation, 1.6% (95% CI: 0.9 to 2.3). Second-generation TAVR devices are associated with very low mortality and major complications rates at 30-day, and improved prosthesis performance with <2% of patients having more than mild post-procedural aortic regurgitation. On the other hand, the need for pacemaker implantation seems to remain an unresolved issue, and warrants further investigation.